Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA.
Open Heart. 2018 Oct 7;5(2):e000816. doi: 10.1136/openhrt-2018-000816. eCollection 2018.
The objective was to assess the impact of procedural characteristics on risk of stroke or transient ischaemic attack (TIA) after transcatheter aortic valve replacement (TAVR).
We included 370 consecutive patients who underwent balloon-expandable TAVR from 1 November 2008 to 30 June 2014. Procedural characteristics that may be associated with stroke/TIA were assessed. The primary outcome was stroke/TIA at 30 days. A propensity score was constructed using a logistic regression model with 29 parameters. Cox proportional hazards models were used with a propensity score covariate.
Mean age was 80.9±7.9 years and mean Society of Thoracic Surgeons score was 8.3±5.0. The total number of balloon dilations ranged from 2 to 7. Out of 370 patients, 13 patients (3.5%) suffered stroke/TIA in the first 30 days after TAVR. In univariate analysis, postdeployment balloon dilation (PD) (HR 3.8, 95% CI 1.24 to 11.61; p=0.02) and emergent cardiopulmonary bypass (CPB) (HR 9.66, 95% CI 2.66 to 35.15; p<0.001) were significantly associated with 30-day stroke/TIA. In the multivariable Cox-proportional hazards model, PD (HR 4.95, 95% CI 1.02 to 24.03; p=0.04) and emergent CPB (HR 7.15, 95% CI 1.39 to 36.89; p=0.02) were independently associated with increased risk of 30-day stroke/TIA after adjusting for propensity score, total number of balloon dilations and periprosthetic regurgitation.
Postdilation as compared with total number of dilations, and emergent CPB were independently associated with increased risk of clinical neurological events in the first 30 days after TAVR. Reduction in balloon postdilation with appropriate valve sizing may reduce the risk of stroke or TIA after TAVR.
评估经导管主动脉瓣置换术（TAVR）后手术特点对中风或短暂性脑缺血发作（TIA）风险的影响。
我们纳入了 2008 年 11 月 1 日至 2014 年 6 月 30 日期间连续 370 例行球囊扩张 TAVR 的患者。评估了可能与中风/TIA 相关的手术特点。主要结局为 30 天内的中风/TIA。采用 logistic 回归模型构建倾向评分，共包含 29 个参数。采用 Cox 比例风险模型，以倾向评分作为协变量。
平均年龄为 80.9±7.9 岁，平均胸外科医师协会评分 8.3±5.0。球囊扩张次数从 2 次到 7 次不等。370 例患者中，13 例（3.5%）在 TAVR 后 30 天内发生中风/TIA。单因素分析显示，球囊扩张后置入（PD）（HR 3.8，95%CI 1.24 至 11.61；p=0.02）和紧急体外循环（CPB）（HR 9.66，95%CI 2.66 至 35.15；p<0.001）与 30 天中风/TIA 显著相关。在多变量 Cox 比例风险模型中，PD（HR 4.95，95%CI 1.02 至 24.03；p=0.04）和紧急 CPB（HR 7.15，95%CI 1.39 至 36.89；p=0.02）在调整倾向评分、球囊扩张总数和瓣周漏后，与 30 天中风/TIA 的风险增加独立相关。
与球囊扩张总数相比，PD 和紧急 CPB 与 TAVR 后 30 天内临床神经事件风险增加独立相关。适当的瓣膜尺寸减少 PD 可能会降低 TAVR 后中风或 TIA 的风险。
